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Don't Believe Old-School Experts! It Is NOT Okay To Fail Half The Time During Sex!

Writer's picture:  Michael Kaplan MD Michael Kaplan MD

I just came across an article that stunned me. A respected urologist said, "Inability to get an erection 20% of the time is not of major concern." Maybe not to him, but to a twenty something year-old man it can be mentally exhausting, or worse. Another urologist said, "It is only when it occurs 50% of the time that a person should consider seeing a doctor." At Uroshock we take erectile dysfunction seriously, since it's our reason for existence. Frankly, I don't know very many guys that want to fail half the time at anything, never mind sex.


Temporary Erectile Dysfunction

It's important to know that anybody can have a slump. Even Steph Curry misses a couple of three-point shots in a row, but he keeps shooting anyway, because he knows he'll start hitting sooner or later. Stress, fatigue, and alcohol can all play a role resulting in temporary ED. It's been said that the greatest aphrodisiac is SLEEP. Certainly if one finds himself in a short-lived streak of challenging sexual encounters an examination of life-style habits might be in order. Easy fixes include:

1) Getting adequate rest

2) Weight-loss

3) Reduction of alcohol and recreational drugs

4) Stress-management techniques

At a certain point it may seem that the challenge is more than temporary. Obviously nobody recommends immediate intervention with invasive therapy for a situation which very well may correct itself. Among the invasive techniques which would not be recommended in this scenario would be injections of medication into the penis (vasoactive therapy), placement of intra-urethral pellets, or surgical implantation of a permanent prosthesis. However, other modalities could be considered when ED is persistent.

Pde5-inhibitors (Viagra, Levitra, Cialis and Stendra) are very safe for most patients. While there may be some loss of spontaneity, and side effects from the medication, the results tend to be very good, especially at first!


Pills like Viagra don't do anything to reverse the underlying cause of ED, which is usually vascular insufficiency. They work by temporarily increasing blood flow, but eventually they may lose their efficacy because the underlying problem continues to advance.

Most recently many patients have been successfully treated with low-intensity acoustic shock waves. Shock waves have been shown in animal models to help recruit stem cells and progenitor cells. This form of regenerative medicine is very safe, and particularly effective for patients in earlier stages of ED. Uroshock is now available for home-use, allowing patients to own their own units and treat themselves without costly and inconvenient doctor visits.


Situational Erectile Dysfunction


Situational erectile dysfunction usually has a psychogenic origin. A patient who has normal morning erections (morning wood) and has firm erections when masturbating, but finds himself unable to get hard with a partner may be suffering from situational erectile dysfunction. Psychological counseling, or guidance from a certified sex therapist may be helpful for these patients. At times, pde5-inhibitors may also be used.


Covid Penis (Covid-Dick)



Unfortunately there is an increasing body of evidence to suggest that Covid-19 increases the risk of erectile dysfunction by a factor of six. https://onlinelibrary.wiley.com/doi/full/10.1111/andr.13003 It is NOT clear if this causes temporary or permanent erectile dysfunction. There does not seem to be any compelling evidence to suggest that vaccinations increase the risk of ED or loss of fertility, despite the concerns of Aaron Rodgers and Nicki Minaj. Patients who develop ED following Covid may consider minimally invasive treatments including pde5 inhibitors, vacuum erection devices, or LiESWT (such as Uroshock.)



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